Healthcare Provider Details

I. General information

NPI: 1740107580
Provider Name (Legal Business Name): TIMOTHY CASEY REID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 BURTON AVE
WASHINGTON PA
15301-3301
US

IV. Provider business mailing address

359 BURTON AVE
WASHINGTON PA
15301-3301
US

V. Phone/Fax

Practice location:
  • Phone: 724-825-6559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC020554
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: